The aims of this study were to estimate the frequency and identify reasons for nonadherence to lifestyle modifications among type 2 diabetic patients. A cross-sectional study was conducted using the Summary of Diabetes Self-Care Activities-Arabic instrument and the Arabic version of the Michigan Diabetes Knowledge Test. A convenience sample was collected. The sample included 410 participants. The mean age of the participants was 61 ± 9.70 years. Of the participants, only 95 (23.2%) had a controlled blood glucose level (glycosylated hemoglobin ≤ 7%). The self-management activities from the most practiced to the least practiced (scale range 0-7) were medications (Mean: 6.28 ± 1.64), foot care activities (Mean: 5.04 ± 2.43), diet activities (Mean: 4.44 ± 2.69), exercise activities (Mean: 3.96 ± 1.97), and blood glucose monitoring (Mean: 0.58 ± 1.28). The majority of participants had acceptable knowledge (63.2%, n = 259). Obese, smokers and rural participants were less likely to adhere to the appropriate diet. P values were 0.012, 0.018, and 0.011, respectively. Regarding regular exercise, obese participants and those with uncontrolled blood glucose levels were less engaged in exercise practice (p values were 0.041 and 0.019). The study concluded that lifestyle modifications were found to be accepted in many aspects. However, there is room for improvement. Effective education and counseling strategies are recommended with a focus on the recognized factors.